Hypothyroidism or Insulin resistance

[melissafry79]

Hi, I am a 28 year old, caucasian female, and was recently put on Glucophage 1000mg BID for insulin resistance.  I originally went to the Endocronologist because of one of my nursing professors, who called me out in class, palpated my thyroid, and told me it was enlarged.  I had a thyroid scan done at the doctors office, which he said looked ok, but I had a small cyst on it, which he stated was normal.  My TSH, T3 and T4 came back within normal limits for the lab values.  I did have very elevated testosterone level, a high glucose level, a high insulin level, all cholesterol/triglycerides elevated, a slightly elevated blood pressure.  My main complaint is my fatigue.  I am tired all the time, can sleep for 16 hours and not feel rested upon wakening...or sleep 7 hours and not feel rested.  I basically just feel totally run down all the time.  I have been irritable and prone to depression, of which I have been on Prozac 20mg daily for the past three years.  I am overweight, 5'7" and 210lbs., but even at 175lbs. The doctor also put me on Adipex 37.5mg in the AM.  I still felt the same....I just feel worse with the extra weight on.  I relayed these findings to my professor, and she still insists there is something wrong with my thyroid, so I am going to seek a second opinion.  Any thoughts on the matter?  I just want to feel better!!

[Mark Lupo, M.D.]

It sounds like a classic PCOS/Insulin resistance case - this is likely the cause of all your symptoms but has been associated with an increased rate of hypothyroidism.  The cyst on the thyroid is not causing these symptoms - knowing the TSH value would be helpful - if not >3 then, not likely any thyroid contribution to the symtpoms.  Even if >3 but still in the "normal range - ie up to 5.5" then there is no data for/against treatment.

[Super_sally888]

Hi Melisa,

the PCOS can definitely be contributing to your problems, so it is right to treat it.  The metformin should help and also try to watch your diet and exercise as much as possible.  PCOS is also associated with a higher incidence of thryoid problems.

I have PCOS and hypothryoid.  Initially my thyroid tests were all within normal range - though TSH was at top of normal range, but I had a doctor who was prepared to diagnose me based on very severe symptoms which she said were quite classic for hypothryoid, and an enlarged thryoid.  She started me off on a low "supportive" dose of thyroxine with the intention of getting my TSH to low normal range and seeing if it helped my symptoms.

It made a great difference in my symptoms and helped a lot.  Over the years since then my thyroid has continued to fail and now I am on pretty much complete replacement.... and my TSH goes up well above normal if my thryoid meds are reduced.

My point is that thryoid problems can develop slowly over time..... and I have read that sometimes the symptoms may be ahead of the blood tests showing distinct abnormalities...

If your thyroid is enlarged, a low dose of thyroxine may be warranted if it is monitored to keep your levels within normal range (TSH should be low normal, probably < 2.0, FT3 and FT4 should be about mid normal range).

Hope this helps.  Dr. Lupo will give good advice.

Sally

[authrjenn]

This is how I started 5 years ago. No one, including doctors, thought that it was anything that needed to be concerned about..Five years later, I just has a 9 months of pure hell, like your describing and a TT. Prozac can pack the pounds on you as well. I have several friends on it And that is one chief complaint. It also interacts with Thyroid problems and can make them worse although some Endo's might dispute that fact. It affects suger levels, hypo-glycemia and diabetics. Its called reactive- hypoglycemia if you want to research it....good luck and I hope this helps you!